HOUSE BILL 263

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Elizabeth "Liz" Thomson and Marianna Anaya and Sarah Silva

and Reena Szczepanski and Anita Gonzales

 

 

 

 

AN ACT

RELATING TO HEALTH CARE; ENACTING THE HOSPITAL PRICE TRANSPARENCY ACT; REQUIRING HOSPITALS TO PROVIDE PRICING INFORMATION ON SERVICES AND ITEMS PROVIDED AT THE HOSPITALS; REQUIRING THE HEALTH CARE AUTHORITY TO IMPLEMENT AND ADMINISTER THE HOSPITAL PRICE TRANSPARENCY ACT; PROVIDING PENALTIES; PROVIDING CIVIL RELIEF TO CONSUMERS.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. [NEW MATERIAL] SHORT TITLE.--This act may be cited as the "Hospital Price Transparency Act".

     SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the Hospital Price Transparency Act:

          A. "ancillary service" means a hospital item or service that a hospital customarily provides as part of a shoppable service;

          B. "authority" means the health care authority;

          C. "chargemaster" means the list of all hospital items or services maintained by a hospital for which the hospital has established a charge;

          D. "collection action" means any of the following actions taken with respect to a debt for an item or service that was purchased from or provided to a patient by a hospital on a date during which the hospital was in violation of the Hospital Price Transparency Act:

                (1) attempting to collect a debt from a patient or patient guarantor by referring the debt, directly or indirectly, to a debt collector, a collection agency or other third party retained by or on behalf of the hospital;

                (2) suing the patient or patient guarantor or enforcing an arbitration or mediation clause in a hospital document, including any contract, agreement, statement or bill; or

                (3) directly or indirectly causing a report to be made to a consumer reporting agency;

          E. "collection agency" means a person that:

                (1) engages in a business for the principal purpose of collecting debts; or

                (2) does any of the following:

                     (a) regularly collects or attempts to collect, directly or indirectly, debts owed or due or asserted to be owed or due to another;

                     (b) takes assignment of debts for collection purposes; or

                     (c) directly or indirectly solicits for collection debts owed or due or asserted to be owed or due to another;

          F. "consumer reporting agency" means a person that, for a monetary fee or dues or on a cooperative nonprofit basis, regularly engages in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties. "Consumer reporting agency" does not include business entities that only provide check verification or check guarantee services;

          G. "debt" means an obligation or alleged obligation of a consumer to pay money arising out of a transaction, whether or not the obligation has been reduced to judgment. "Debt" does not include a debt for business, investment, commercial or agricultural purposes or a debt incurred by a business;

          H. "debt collector" means a person employed or engaged by a collection agency to perform the collection of debts owed or due or debts asserted to be owed or due to another;

          I. "de-identified maximum negotiated charge" means the highest charge that a hospital has negotiated with all third-party payors for a hospital item or service;

          J. "de-identified minimum negotiated charge" means the lowest charge that a hospital has negotiated with all third-party payors for a hospital item or service;

          K. "discounted cash price" means the charge that applies to a person who pays cash or a cash equivalent for a hospital item or service;

          L. "gross charge" means the charge for a hospital item or service that is reflected on the hospital's chargemaster, absent of any discount;

          M. "hospital" means a public hospital, profit or nonprofit private hospital or a general or special hospital that is licensed as a hospital by the authority;

          N. "item or service" means an item or service that could be provided by a hospital to a patient in connection with an inpatient admission or an outpatient department visit for which the hospital has established a standard charge, including any of the following:

                (1) a supply or procedure;

                (2) room and board;

                (3) a facility fee;

                (4) a professional fee; or

                (5) any other item or service for which a hospital has established a standard charge;

          O. "machine-readable format" means a digital representation of information in a file that can be easily imported or read into a computer system for further processing without any additional preparation;

          P. "payor-specific negotiated charge" means the charge that a hospital has negotiated with a third-party payor for a hospital item or service;

          Q. "professional fee" means a fee charged by a health care practitioner for medical services;

          R. "shoppable service" means a service that may be scheduled by a person in advance;

          S. "standard charge" means the regular rate established by a hospital for a hospital item or service provided to a specific group of paying patients. "Standard charge" includes the:

                (1) gross charge;

                (2) payor-specific negotiated charge;

                (3) de-identified maximum negotiated charge;

                (4) de-identified minimum negotiated charge; and

                (5) discounted cash price; and

          T. "third-party payor" means an entity that is legally responsible for payment of a claim for a hospital item or service.

     SECTION 3. [NEW MATERIAL] PUBLIC AVAILABILITY OF PRICE INFORMATION REQUIRED.--

          A. Each hospital shall publish the following information on the hospital's publicly accessible website:

                (1) a digital file in a machine-readable format that contains the following information for each item or service provided in either an inpatient setting or an outpatient setting:

                     (a) the gross charge;

                     (b) the de-identified minimum negotiated charge;

                     (c) the de-identified maximum negotiated charge;

                     (d) the discounted cash price;

                     (e) the payor-specific negotiated charge, delineated by the name of the third-party payor and plan. A hospital shall include all payors and plans accepted by the hospital; and

                     (f) a code used by the hospital for the purpose of accounting or billing for the hospital item or service, including the current procedural terminology code, the healthcare common procedure coding system code, the diagnosis-related group code, the national drug code or other common identifier; and

                (2) a consumer-friendly list that contains information for at least three hundred shoppable services provided by the hospital with charges specific to that individual hospital location. The hospital may select the shoppable services to be included in the list, except that the list shall include the seventy services specified as shoppable services by the federal centers for medicare and medicaid services. If the hospital does not provide all of the shoppable services specified by the federal centers for medicare and medicaid services, the hospital shall include all of the shoppable services provided by the hospital. If a hospital does not provide three hundred shoppable services, the hospital shall include the total number of shoppable services that the hospital provides. The list shall include the following information for each shoppable service and any associated ancillary service:

                     (a) a plain-language description;

                     (b) the payor-specific negotiated charge, delineated by the name of the third-party payor and plan. A hospital shall include all payors and plans accepted by the hospital;

                     (c) the discounted cash price or, if the hospital does not offer a discounted cash price, the gross charge;

                     (d) the de-identified minimum negotiated charge;

                     (e) the de-identified maximum negotiated charge; and

                     (f) a code used by the hospital for purposes of accounting or billing for each item or service, including the current procedural terminology code, the healthcare common procedure coding system code, the diagnosis-related group code, the national drug code or other common identifier.

          B. A hospital shall make all information required to be published under this section available to the public by posting the information in a prominent location on the home page of the hospital's publicly accessible website or making the list accessible by a dedicated link that is prominently displayed on the home page of the hospital's publicly accessible website. If the hospital operates multiple locations and maintains a single website, the hospital shall post the specific information for each location that the hospital operates in a manner that clearly associates the information with the applicable location of the hospital.

          C. A hospital shall ensure that all information required to be published under this section is:

                (1) available free of charge;

                (2) accessible to a common commercial operator of an internet search engine to the extent necessary for the search engine to index the list and display the list in response to a search query of a user of the search engine;

                (3) formatted in a manner that complies with the Hospital Price Transparency Act and any requirements set forth by the authority; and

                (4) digitally searchable by service description, billing code and third-party payor.

          D. A hospital shall not restrict access to the information required to be published under this section by requiring:

                (1) the establishment of a user account or password;

                (2) the submission of personal identifying information; or

                (3) any other impediment, including entering a code to access the information.

          E. The authority shall develop a template that each hospital shall use in formatting the information required to be published under Paragraph (1) of Subsection A of this section. When developing the template, the authority shall:

                (1) take into consideration applicable federal guidelines for formatting similar information required by federal law;

                (2) ensure that the template's design enables a person to compare charges for items or services provided at each hospital; and

                (3) design the template to be substantially similar to the template used by the federal centers for medicare and medicaid services for purposes similar to this section.

          F. A hospital shall update the information required to be published under this section no less than once each year. The hospital shall clearly indicate the date when the information was most recently updated. The hospital shall make all versions of each list available for at least seven years.

          G. When selecting a shoppable service for the purpose of inclusion in the list published pursuant to Paragraph (2) of Subsection A of this section, a hospital shall:

                (1) consider how frequently the hospital provides the service and the hospital's billing rate for the service; and

                (2) prioritize the selection of services that are among the services most frequently provided by the hospital.

          H. Any information on the price of an item or service, or the amount charged for an item or service, required to be published under this section shall be expressed in United States dollars.

     SECTION 4. [NEW MATERIAL] REPORTING REQUIREMENTS.--

          A. Each time a hospital creates or updates a list required to be published by the Hospital Price Transparency Act, the hospital shall submit the list to the authority.

          B. The authority shall make all lists available on the authority's website within sixty days of receipt of each list.

          C. The authority shall annually submit a report to the legislative finance committee and the interim legislative health and human services committee on the progress in implementing and administering the Hospital Price Transparency Act.

     SECTION 5. [NEW MATERIAL] ENFORCEMENT.--

          A. The authority shall establish an electronic form for individuals to submit complaints for alleged violations of the Hospital Price Transparency Act. The authority shall post the electronic form on the authority's website. The authority shall also accept complaints via a customer service telephone number.

          B. A hospital shall be in violation of the Hospital Price Transparency Act if the hospital:

                (1) for any item or service, charges a patient more than the dollar amount published in the lists required under Paragraphs (1) and (2) of Subsection A of Section 3 of the Hospital Price Transparency Act;

                (2) violates the provisions of the Hospital Price Transparency Act or the rules promulgated pursuant to that act;

                (3) fails to take immediate action to remedy a violation of the provisions of the Hospital Price Transparency Act or the rules promulgated pursuant to that act;

                (4) fails to submit a plan of correction in accordance with the requirements of this section;

                (5) fails to comply with a plan of correction; or

                (6) violates an order previously issued by the authority in a disciplinary matter.

          C. Upon determining that a hospital has violated the provisions of the Hospital Price Transparency Act or the rules promulgated pursuant to that act, the authority shall issue a written notice to the hospital stating that a violation has been committed by the hospital. The written notice shall:

                (1) state that the hospital is required to take immediate action to remedy the violation or, if the hospital is unable to immediately remedy the violation, submit a plan of correction to the authority; and

                (2) state that the hospital is required to provide prompt confirmation to the authority that the corrective action has been taken.

          D. If a hospital is required to submit a plan of correction to the authority, the authority may direct that the violation be remedied within a specified period of time. The hospital shall submit the plan of correction within thirty days of the authority's issuance of the written notice.

          E. The authority may impose a civil penalty for violations of the Hospital Price Transparency Act in an amount not to exceed:

                (1) two thousand five hundred dollars ($2,500) for a first incident;

                (2) five thousand dollars ($5,000) for a second incident;

                (3) ten thousand dollars ($10,000) for a third incident; and

                (4) fifteen thousand dollars ($15,000) for a fourth or subsequent incident.

          F. Each day that a hospital violates the Hospital Price Transparency Act constitutes a separate and distinct incident.

          G. The authority may audit a hospital's website to ensure compliance with the Hospital Price Transparency Act.

          H. A hospital that is in violation of the Hospital Price Transparency Act on the date when an item or service is provided to a patient shall not initiate or pursue a collection action against the patient or patient guarantor for a debt owed for the item or service.

          I. If a patient or a patient guarantor believes that a hospital is in violation of the Hospital Price Transparency Act on the date when an item or service is provided to the patient and the hospital takes a collection action against the patient or patient guarantor, the patient or patient guarantor may initiate a civil action in a court of competent jurisdiction to determine if the hospital is in violation of the Hospital Price Transparency Act. The hospital shall not take a collection action against the patient or patient guarantor or submit a report to a patient's or patient guarantor's credit report while the civil action is pending. If the court of competent jurisdiction determines that the hospital is in violation of the Hospital Price Transparency Act and the violation is related to the items or services for which the patient was charged, the hospital shall:

                (1) refund the payor an amount of the debt the payor has paid and pay a penalty to the patient or patient guarantor in an amount equal to the total amount of the debt;

                (2) pay any attorney fees and costs incurred by the patient or patient guarantor relating to the action; and

                (3) remove or cause to be removed from the patient's or patient guarantor's credit report a report made to a consumer reporting agency relating to the debt.

          J. Nothing in the Hospital Price Transparency Act shall be construed to:

                (1) prohibit a hospital from billing a patient, patient guarantor or third-party payor, including a health insurer, for an item or service provided to a patient in a manner that is not in violation of the Hospital Price Transparency Act; and

                (2) require a hospital to refund a payment made to the hospital for an item or service provided to a patient if no collection action is taken in violation of the Hospital Price Transparency Act.

     SECTION 6. [NEW MATERIAL] INFORMATION REQUIRED TO BE PROVIDED TO PATIENTS.--Prior to commencing a collection action, a hospital or a debt collector acting on behalf of a hospital shall provide a patient with:

          A. an easy-to-understand itemized statement of the medical debt owed by the patient to the hospital, which shall include the applicable billing codes for each item or service, using commonly recognized billing code sets;

          B. a copy of the detailed receipts of any payments made to the hospital or debt collector by the patient or the patient's guarantor within thirty days of each payment;

          C. information about the availability of language-assistance services for persons with limited proficiency in English; and

          D. the contact information for an office or individual at the hospital that can:

                (1) discuss the specific details of an itemized statement; and

                (2) make appropriate changes to the statement.

     SECTION 7. [NEW MATERIAL] RULEMAKING.--The authority may promulgate rules necessary to implement and administer the Hospital Price Transparency Act.

- 16 -